STANDARD-DOSE VERSUS HYPOFRACTION-ATION RADIOTHERAPY FOR ADVANCED NON-SMALL CELL LUNG CANCER (NSCLG): A PRELIMINARY ANALYSIS

Introduction: Concurrent chemoradiation (cCRT) is the standard treatment for locoregionally advanced NSCLC. Chemotherapy followed by radiotherapy (RT) (sequential treatment) or even exclusive RT maybe an option for cases with very large tumor and/or for patients with unfavorable clinical condition. Our institutional protocol recommends hypofractionation RT (HypoRT) for sequential or exclusive RT (when cCRT is contraindicated). Objective: To compare the survival and toxicity results of the standard-dose of cCRT (recommended 60Gy in 30 fractions) versus sequential/exclusive HypoRT (recommended 55Gy in 20 fractions) for locoregionally advanced NSCLC. Methodology: Retrospective cohort study. From January 2014 to October 2018, patients with locoregionally advanced, non-metastatic and inoperable NSCLC undergoing RT with radical intention in a single institution was selected. Fifty-sevenpatients who met the eligibility criteria were identified. Survival was calculated by the Kaplan-Meier method and toxicities were analyzed using Chi-square test and Fishers exact test. Results: The preliminary data shown a ratio of 1:2 between cCRT (19 patients -33.3%) and HypoRT (38 patients - 66.7%). The median total dose of the CRT group was 60Gy (2Gy/faction) and the median total dose of the HypoRT group was 55Gy (2.75Gy/fraction). The median follow-up was 21 months (range 4-48 months). The 2-years Progression-Free Survival (2yPFS) was 57 x 80% for the cCRT and HypoRT group (p = 0.15), respectively. The 2-years Overall Survival (2yOS) was 60% for the entire population. The 2yOS was 47% for cCRT and 68% for HypoRT group (p= 0.62). The treatment was well tolerated for both groups. The grade 1/2 esophagitis, grade 1 vomiting, grade 2 fatigue and grades 1/2 dermatites acute toxicity rate were 50 × 43.6%, 5.6 × 2.6%, 5.6 × 7.7% and 44.4 × 33.3% for the cCRT and HypoRT group, respectively. Grade 1 pneumonitis was 6% for both groups. Conclusion: Our data suggest that exclusive or sequential HypoRT is associated with acceptable survival and toxicity for locoregionally advanced NSCLC and could be considered and alternative for patients not suitable to receive cCRT.

Publication History

Article published online:
23 October 2019